Forrester Joseph D, Cai Lawrence Z, Mbanje Chenesa, Rinderknecht Tanya N, Wren Sherry M
Stanford University, Stanford, CA, USA.
College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe.
Trop Med Int Health. 2017 Oct;22(10):1223-1232. doi: 10.1111/tmi.12937. Epub 2017 Aug 31.
To describe the impact and epidemiology of Clostridium difficile infection (CDI) in low- and middle-human development index (LMHDI) countries.
Prospectively registered, systematic literature review of existing literature in the PubMed, Ovid and Web of Science databases describing the epidemiology and management of C. difficile in LMHDI countries. Risk factors were compared between studies when available.
Of the 218 abstracts identified after applying search criteria, 25 studies were reviewed in detail. The weighted pooled infection rate among symptomatic non-immunosuppressed inpatients was 15.8% (95% CI 12.1-19.5%) and was 10.1% (95% CI 3.0-17.2%) among symptomatic outpatients. Subgroup analysis of immunosuppressed patient populations revealed pooled infection rates similar to non-immunosuppressed patient populations. Risk factor analysis was infrequently performed.
While the percentages of patients with CDI in LMHDI countries among the reviewed studies are lower than expected, there remains a paucity of epidemiologic data evaluating burden of C. difficile infection in these settings.
描述低收入和中等人类发展指数（LMHDI）国家艰难梭菌感染（CDI）的影响及流行病学特征。
对PubMed、Ovid和科学网数据库中描述LMHDI国家艰难梭菌流行病学及管理的现有文献进行前瞻性注册的系统文献综述。如有可用数据，对各研究间的风险因素进行比较。
在应用检索标准后识别出的218篇摘要中，对25项研究进行了详细综述。有症状的非免疫抑制住院患者加权合并感染率为15.8%（95%置信区间12.1 - 19.5%），有症状的门诊患者为10.1%（95%置信区间3.0 - 17.2%）。免疫抑制患者群体的亚组分析显示合并感染率与非免疫抑制患者群体相似。风险因素分析很少进行。
虽然在纳入综述的研究中，LMHDI国家CDI患者的百分比低于预期，但在这些环境中评估艰难梭菌感染负担的流行病学数据仍然匮乏。
